Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: sobriety (page 2 of 6)

Blackouts: The Alcoholic Litmus Test

Blackout.

I heard a story the other day from a guy who said I could share it here. This guy was talking about how, before he quit drinking and drugging 20 years ago, he wasn’t sure whether his blackouts really qualified him as an alcoholic. An old-timer pulled him aside and told him the story of another guy who wasn’t sure whether he was in fact truly blacking out. The idea is—how can you remember what you don’t remember, right? And the rationalization goes, If I can’t remember what I don’t remember, maybe there’s in fact nothing to remember, maybe I’m not exactly blacking out, maybe I just had a little bit too much and need to “be careful.”

The guy in the story stops at the bar and gets drunk. He wakes up the next morning and realizes he’s not sure exactly how he got home the night before. He checks to see if he’s OK. He gets ready for work and can’t find his car keys. He asks his wife to go down to the garage and check that they’re there. And she goes down, and she screams.

“What’s the matter?” he calls.

She comes upstairs and tells him that, yes, the keys are there. And also: there is a dead child lying on the front of the car.

The guy who told me this story said that the day after hearing it, he got his ass to rehab.

Was it a true story? Who knows. It could have been true, right? I don’t know about you, but I certainly drove while f*@ked up.

Recently I’ve been thinking about how I used to drink heavily. I’m getting ready for my 25th college reunion. College was the moment in my life where I started drinking. I could say: it was where I started doing what I saw people at home doing every day—using chemicals to make themselves feel better. I was able to do it at college because there was nobody around to tell me not to do it. That’s the way I ran my life: I did what I could get away with, I mean, who didn’t live that way?

(Most people.)

At my college, at that time, booze was rampant. You weren’t supposed to have alcohol on campus, but everyone did, and if you were a cute little 20-year-old undergraduate girl, the security guys let you off the hook fairly easily. Off-campus, the kegs rolled. Actually, grain-alcohol punch was the big thing. We made it with fruit slices (reputed to soak up all the alcohol). Or, rather, I never made it myself. I always drank other people’s grain-punch for free.

I had my first drink at 17 at one of those parties. My parents dropped me off on Saturday morning, and by that night I was standing in some strange house, and some upperclass boy was making me a gin-and-tonic, which if I remember correctly—he filled a tall iced-tea glass with gin and splashed a little tonic in. I drank about an inch of it and was pretty gone. Wasted, hammered, trashed.

I remember thinking, Is this the way Daddy feels EVERY DAY? (Of course it was not the way Dad felt every day, Dad drank the five or six or seven or ten beers he drank every day just to keep himself feeling normal, but it was a long time before I realized that in any experiential manner—and it wasn’t with alcohol that I realized it.)

The upperclass boy groped me and sucked my face and it was all very Exotic and Independent, and though I hated the taste of all the drinks I ever had in school, even wine—even wine spritzers (a crappy ’80s invention)—I drank them anyway not because I enjoyed them but:

  • because above all I needed to be like all the other girls, and
  • because I needed to get away from the war in my head.

In fact, as it turned out, I was not like all the other girls. Most of the other girls knew when to stop drinking.

In fact, trying to drink away the war in my head was like trying to douse a fire with—well, Cointreau? Ouzo? something very fume-y and volatile, anyhow.

The year after I graduated from that school I went to my old roommate’s wedding. I was pissed at my date, who had intentionally picked out a truly revolting suit to wear to this wedding—at which some of my old friends would be present, including some young men who had expressed an interest in me; this was the main thing that mattered to me: how people saw me, whether they approved of me. And because the guy I was dating also drank way too much way too often, he knew this about me and bought the suit to take me down a peg or two. Or else, he just didn’t give a shit. Pick one. … And he made fun of these people even though he didn’t know them—like my father he’d get drunk, and like my mother he’d make fun of my friends, and it was this kind person I chose for my first post-college Relationship.

I had made a beautiful linen coat-dress to wear, with tailored seams and asymmetrical buttons and an invisible hand-sewn hem. Moreover I had starved myself to be able to look super-brilliant in this dress—to Make An Impression—and meanwhile this guy with two degrees and a thriving Private Practice bought this vile bullshit suit from a dollar store or somewhere, and there was no way I could deal with the fact that I had to appear with this asshole in church and then at the reception at the exclusive restaurant at the top of the mountain overlooking the city.

It occurs to me now, of course, that I had choices, one of which was either To Be Or Not To Be with this man, another of which was to tell him that after all he couldn’t come with me if he refused to make himself presentable. But the only choice I thought I had at the time was to show up with him, then drink so much that I didn’t feel the war taking place in my head.

And so I drank, and I drank some more, and I became very drunk indeed, in my accustomed manner: on my friend’s open bar at her wedding reception. I became so drunk that I don’t remember crashing my car while driving down the mountain. I woke up in the emergency room, across the river, while one doctor sewed up the half-moon gash on my head and another doctor picked glass out of my knees and arms. My date was in the bed next to me.

“Why did he let you get in the car?” my mother moaned the next day. (My mother was very good at taking other people’s inventory.)

At that time, if you were a cute 20-something professional-looking girl who crashed her car with a sky-high blood-alcohol level, the cops (it was cops now, not just security guards but COPS; it wasn’t just college policy but The Law) didn’t arrest you. They took one look at your face and let you off.

The police report said the other car had crossed the line. Still, I was sued by both people in the other car, and eventually (two years after I dumped him, just before the statute of limitations ran out) by my old boyfriend, and because my blood alcohol level was in fact sky-high, my insurance paid out a great deal of money and my policy was cancelled.

I stopped drinking for a while after that. Then I went to graduate school and began drinking again, although with some trepidation. Pretty soon after that I sought treatment for my intractable migraines (which an MRI proved were not a result of my head injury), and the painkiller dance started.

I never blacked out again. For a long time, even after I detoxed and started going to meetings, I viewed this episode as a youthful misadventure, something that “happens” when you’re young but that you grow out of—sort of like a kid who climbs trees but keeps falling out of them. Denial runs very strong and deep in my family. … Recently I was discussing this car-crash with my sister, five years younger than I. I forget exactly what I said because her reaction was so extreme, but I mentioned in passing the fact that I was drunk at the time of the crash.

“You were DRUNK??!” she screeched, incredulous. This is what, 24 years later? It took me about two seconds to realize that my parents had hidden the truth from her because they were ashamed of me. A lie of omission. I expected to feel overwhelming disgrace, but what I felt was relief. I love my sister deeply, and love can only stand on a foundation of truth.

“It doesn’t surprise me that they hid the most important and embarrassing detail from you,” I said.

It wasn’t long after revealing this truth to my sister that I realized fully that, the evening of that wedding, I had blacked out. I had driven in a BLACKOUT. I cannot remember what happened in that space of time.

“Blackout” is also called, in technical terms, “alcohol-related amnesia.”

It wasn’t just the head injury, the concussion, that carved out that black hole. It was the alcohol. It was the addiction.

Motherhood and My Addiction: By Guest Poster Tara

Guest poster Tara, who blogs about sobriety at The Act of Returning to Normal, writes today about how her alcoholism and her motherhood were intertwined—she drank to soothe her fears that she wasn’t a “good-enough mother”… and, later, she got sober in part out of her desire to give her kids a sober mom. I’m grateful to Tara for this post—I so closely identify with her feelings about motherhood: intimidation; inferiority; setting up the goal of perfection, and never being able to meet it.

Tara, I’m so glad you’re sober today. 🙂 Happy Mother’s Day.

Readers interested in guest-posting can email me at guinevere (at) guineveregetssober (dot) com.

***

Motherhood and My Addiction

by Tara

Drinking motherDuring the last few months of my drinking in the summer of 2010, I was in a serious funk. Believing that my problem was a depression that had nothing to do with the copious amounts of alcohol I consumed, I considered going to my doctor to ask for anti-depressants. The part of me that was concerned about my drinking was also convinced that if I wasn’t suffering from depression, I would definitely have to cut back. I couldn’t contemplate quitting altogether, largely because it seemed impossible, like running a marathon. So I pondered anti-depressants, but procrastinated about making a plan to take them. Part of me was afraid I would never be able to drink normally, even if I did feel better.

It was summer and I was working from home. My kids were at summer day camp. I drank vodka at lunch every day. Cautious about consuming too much, I measured the portions carefully, stopping after lunch so that I wouldn’t be too drunk to drive to camp to pick them up. Each morning I promised myself that I wouldn’t drink until after they got home. By lunch each day I broke my promise. Later, I would thank God that I had this one small responsibility. I think it was the only thing that prevented a complete downward spiral into absolute drunkenness. I believe if not for that one ten-minute drive each day that I would have started drinking after breakfast.

The weekends were a different story. It was during this summer, on the weekends, that I began drinking before lunch while my family was out grocery shopping and I was home alone cleaning up the house. Looking back, I’m not sure why drinking in the mornings seemed necessary, but I wanted solace from an anxiety I couldn’t shake. I wanted to recapture the wake-and-bake feelings I had in my early twenties—that feeling that all was well with the world. Back then, I lived in San Francisco and smoked pot all the time; then, it seemed okay to chase peak experiences because it aligned with my desire to be more laid back, more “Californian.” I was trying to change myself the only way I knew how, from the outside in, and saw smoking pot as a style choice, on a par with wearing bell-bottomed pants and listening to folk music. I stopped smoking pot in 2001 when I was pregnant with my first child. At the same time, I put away my bell-bottoms. In my mind, getting high was tied to youthful exploration and at odds with my new sense of responsibility to my daughter. It was easy to let it go.

Ten years later it seemed I still wanted the hard edges of life to melt away so that I could be left with a good feeling. I wanted to be there for my kids but I felt like I wasn’t good enough as I was. In order to be a good mother, I believed I had to reshape myself into someone who loved them enough to help them, to listen to their stories, and to automatically have all of the right answers. I wanted to give them a sense of self-confidence and well-being my parents hadn’t given me. When I was drunk—just enough—I thought the “bad mother” parts of me moved into the shadows. I thought that I had to feel good to be a good mother. I thought that to feel bad meant I was bad.

There were many tangible moments that underlined my sense of failure at motherhood: “forgetting” to sign up for sports because practice was scheduled for times I typically drank, and hurrying along the bedtime routine because I needed to get back to my glass. I’m also sure there were embarrassing moments I don’t remember: slurred words,  stumbling, and forgetfulness. I loved my kids more than anything else, but I couldn’t fully accept that my drinking prevented me from connecting deeply with them.

Then two things happened that finally led me to seek sobriety. First, in a fit of pain over my failures in parenting, I tried to hurt myself. I don’t say kill, because I don’t think that was my intention at the time, although clearly it could have been a consequence. Second, my mother-in-law lost her temper because she saw everyone in the house tiptoeing around, pretending we were fine. She now admits that it drove her crazy to be with us, because although she couldn’t put her finger on why, she knew things were not good. Her anger wasn’t specifically directed at my drinking, even though she definitely thought I drank too much and saw through the lies I told her about cutting back. She knew that my life was unmanageable even though she didn’t know the truth about when or how much I drank.

After going through these two things, I was finally able to accept that things were not “fine.” I understood I had lost myself completely and I would never get out of the mess I was in—unless I first stopped drinking. This comprehension humbled me and for the first time in over ten years I asked to be released from my addiction. I prayed every day and counted the minutes. It sounds simplistic, even now, but for the first time in years I was able to put more than one or two days of sobriety together. This simple prayer worked for a few weeks, until I realized I needed help if I were going to put any amount of time together. I found AA and it helps me to stay sober.

After months of drunken contemplation about whether my family would be better off without me, when I got sober I understood the pain my kids would feel if I just disappeared. My memories of the night I tried to hurt myself, and the scars on the inside of my wrist, keep me focused on the fact that no matter how shitty things may seem now, they were truly shitty when I was drinking.

G Gets Strong: What Do You Think Is Impossible For You?

Guinevere’s baby twin-pack

Day 71 of my 90-day fitness program.

During my workout last night I noticed I have two baby abs. (My son tried to make it into four but, poking just under my bra-line, he said, “No, you’re right, I think those are ribs.”  :))

This is not a vanity photo. This is evidence… This is an illustration for a story about a little girl who used to fall off the monkey bars in the playground and, in high school, couldn’t run even once around the football field without stopping to walk.

She came to believe she was “just not the kind of person” who was strong… and never would be that kind of person. In fact, she was taught she shouldn’t want to be that kind of person. It was just one of those choices in life—You’re either smart, or you’re strong. Pick one. You can’t have both.

This is the story of a girl who started, in tenth grade, having migraines that made her cry involuntarily, and still had to perform for her flute teacher with her right eye half-closed in pain—because her mom did not want the ten bucks spent on the lesson to go to “waste.”

And so she formed her priorities. And a lot of resentments and fears.

This girl grew up and the physical pain only got worse and worse… It wore her down and became entwined with the emotional pain, and though she knew she probably had “a problem” with medications she thought, Screw it, I’m defective, I’m broken, I’m physically weak and always will be.

Eventually she was told she had fibromyalgia and was, to her relief (and eventual delight), given opioid drugs to take every day, hydrocodone and morphine and OxyContin and fentanyl, one after the other, some times one with the other, and was told she might have to take them forever, because there is no cure for fibromyalgia or migraine—no one even knows what really causes them.

The drugs got stronger and stronger, more and more. They made her not-care about practically everything. That was what she wanted—not to care. She asked for the drugs, sometimes by name, and because she looked and sounded so professional and reliable, her wishes were granted.

This woman let stress and worry get to her so much that her muscles clenched, even in sleep, no matter how much medication she took. She came to believe “it would always be this way” and threw in the towel.

Then by the grace of God or HP or Whatever, she got sober. She asked for help.

This girl is now 46 and is two-and-a-half years off drugs and one year sober and is here to tell you: She can now do 50 pushups during a workout, can do three pull-ups without using her foot to help her up, and can do 13 dive-bombers (not the Hindu push-ups, the real thing) when on Day 1 she couldn’t do any.

Even her son trying to make the two abs into four feels strange for her… because she’s so used to the voice rooted inside that says, Those aren’t abs, who do you think you’re trying to fool, you can’t be that fit because YOU’RE G. You’re the one who fell off the monkey bars.

Well, not any-friggin-more she’s not.

HP told her last year to get going on the physical fitness… And she said OK, and went to any lengths just like she went to any lengths to get sober, and she’s finding that fitness in general is like a mathematical equation:

WILLINGNESS + EFFORT = RESULTS

And amazingly, she has LESS pain. The more physically fit she gets, the less pain she has. The more spiritually fit she gets, the less emotional pain she has—less often, and of shorter duration.

Because she is stronger. And because she has people around her, God/HP/Whatever bless them, who are willing to help her. Because she asked for help.

And now there are lots of possibilities going through her mind.

She is now thinking… What else do I think I can’t do, that I’ve always wanted to do??

This list is growing. She has found out that she’s hardly ever made lists like this before.

Wow.

Her fear still crops up

(what if i can’t do it what if i screw it up what if what if)

but she looks at the picture of her little baby abs and thinks, Wow. This gives her the guts to keep walking the walk. One foot in front of the other.

What do you think you can’t do? … I am here to tell you: You can do it.

Give it a shot.

Sober Life: Being A Sober Mom

Said goodbye this morning to my 13-year-old, watching him shamble down the front steps into the first mild morning we’ve had this year. There was something about how he looked walking toward the school bus, wearing the new coat that he calls his “rock-star coat,” which he bought on his own when he walked with his friends from our house down to the shops last week… I watched him from behind, and coupled with that feeling that he’s no longer my little boy came a regret that I’d spent a number of years of his early childhood unsober.

I shut the door, locked it, walked back into the kitchen and started washing the dishes from breakfast before settling down to work. Pretty soon my tears were dripping into the dishwater. Sometimes I can’t do anything about it: I Regret The Past and Wish To Shut The Door On It.

Thirteen years ago, I was a fearful new mom. The fear settled on me as soon as I knew I was pregnant. I knew I was pregnant even before I took the drugstore test. I could feel it in my body. I’d gotten pregnant by accident and after the second line in the pregnancy test’s window confirmed what I already knew, I stood in the front hall and burst into tears—I was sure I had no idea how to raise a kid, and I had no confidence that I could figure it out. I read lots of books, and I even wrote a book about my pregnancy (which was great—my pregnancy, that is), but books didn’t give me that sense of Being Right inside myself.

My son, at a couple weeks old. From my first book. (Photo by Charlee Brodsky.)

When my son was born, and I saw his face, I knew he was the one I was supposed to meet. You know what I mean? His eyes were open. They were stone-colored, and he looked hard at me. I was absolutely flattened by love. I swore to myself I’d do my best.

My best turned out to be several years of addiction.

I got sober when he was turning 11.

As I finished washing the dishes I thought to myself how I can’t turn the clock back. My kid is one person I have to make living amends to. You can’t go to a child and tell him the ways you’ve harmed him… The facts of parenthood force me to live as an example of sobriety, to live as healthily and as spiritually-directed as I can today. Letting the rest go is the hard part. The self-recrimination. The thoughts, when I look into his face, of “what if?” What if he’d been given a different mother. What if I’d been able to get sober earlier. Blah blah blah, self-pity.

I know how I’m supposed to think. I’m supposed to stay in the present moment.

Doing the dishes and cleaning the kitchen always makes me think of my own mother. She taught me specific ways of house-cleaning. She did not tolerate drips or crumbs on the countertop. She did not tolerate leaving dishes in the sink. We didn’t have a dishwasher. She used to point to her piano (which is now in our front hall) and say, “There’s my dishwasher”—to emphasize the point that she’d chosen to invest in a musical instrument rather than a kitchen appliance.

I used to think at those moments that, actually, I was the dishwasher, and so was my sister, but I never said so.

We didn’t even have a sink-sprayer. There was a little cup by the faucet that we used to rinse out the sink. (Of course, we had no disposal.)

This morning as I wiped the countertop clean I thought of my mother. She’s been dead of lung cancer from smoking, it’s been almost 12 years.

Recently my father-in-law died, and my husband, on the first night after his dad’s death, curled up next to me in bed and asked, “Where do you think we go after we die?” It was a childlike question borne of childlike feelings. I thought of my mother then. There is nothing left of my mother’s body, surely, except her bones. Her grave is on a hillside 15 miles to the east of here. But can it be said that there is nothing left of her, when I so diligently empty the sink, when I wipe the countertop clean… when I beat myself over the head for making mistakes—the way she taught me?

Instead of doing my yoga at home today, I went to my friend Jenn’s class. I needed to get out of the house, and I needed to hear Jenn’s voice. As I walked in, she was already leading the students in opening meditation. I sat down on my mat, and Jenn said, “Now think of a place of comfort,” and the first thing that came to my mind was my  mother’s lap when I was a child. I could feel her shoulders under the blue-and-brown flannel shirt and I could smell her cigarette smoke, and I could hear her voice. Though my mother hit me when I was small, I also remember how much I used to love it when she sometimes held me on her lap. She also sometimes sang, or read books.

I held my son, I sang to him, I read to him… even when I was not sober…

I started to cry in the yoga studio. (I was in the back…)

One problem I’ve had is that I made my mother my higher power. I did everything she said, down to wiping the countertops clean in a certain way. I am a good reporter and student because I can remember conversations and lectures verbatim, because I was trained to remember things my mother said (or else).

I can see that my son won’t have some of these problems. I’m not his higher power. He is not my confidante. He has privacy, and a good relationship with his father, and productive friendships. There are appropriate boundaries between us.

Driving home from yoga I was thinking that, at the very least, I’m here. I’m alive and well, if not perfect. (By now you will have noticed that I’d like to be perfect… 🙂 ) I think kids are hardwired to forgive their parents, especially if their parents make an effort. If my mother had gotten well, and had lived to see my son grow up, I could have let go of everything that had gone before.

I mean, by the time she died, I had let go of it anyway. … Anyone know what I mean?

But who knows how much possibility for growth, how much joy we might have had?

And she would have been here. Priceless.

//

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Suboxone: Amazing Detox Tool, Monster Maintenance Drug.

An Expert Talks About Suboxone: Dr. Steven Scanlan of Palm Beach Outpatient Detox

Steven Scanlan M.D.

Steven Scanlan M.D., medical director of Palm Beach Outpatient Detox

Steven Scanlan, M.D. is board-certified in psychiatry and addiction medicine. In his practice, Palm Beach Outpatient Detox (PBOD), on the Florida coast, he has detoxed more than a thousand patients off many drugs, including alcohol, benzodiazepines (Valium, Xanax, etc.), and sleep aids. But his specialty is opiate detox.

Scanlan has been practicing as medical director of PBOD for about two years. His practice, he said, is located in an area where more than two-thirds of all oxycodone prescriptions in the nation are issued—the south Florida coast that has become notorious for its “pill mills.”

Scanlan said 70 percent of his patients come to him addicted to oxycodone at levels of about 300 to 600mg per day. About 20 percent also come in with alcohol problems. “The rest use Vicodin and Ultram,” and a few come in addicted to Fentanyl, he said.

And then there are the increasing numbers who come to him desperate to get off Suboxonea drug that combines buprenorphine, a synthetic partial-agonist opioid, with another drug to prevent abuse. Suboxone (commonly known as “Sub” by people with addiction) is used in opiate detox and maintenance, it’s known and “prison-heroin,” and it’s now commonly sold on the street.

Scanlan says he has seen Suboxone work brilliantly as a detox tool and dangerously as a maintenance drug.

I first heard Scanlan speak on a podcast that’s now defunct. Two reasons I was eager to talk to him:

1. Scanlan chose addiction medicine as a result of his own recovery from opiate addiction. He understands addiction from personal and professional experience. While training to become an anesthesiologist Scanlan became addicted to Fentanyl, a strong opioid used in surgical procedures and for severe pain. After trying many times to quit on his own, he found a physician who helped him detox over two weeks using Subutex—plain buprenorphine—and other medications to ease the detox symptoms. He joined a recovery program, then decided he was well equipped to help others suffering from the same problem. Many of his physician colleagues didn’t like working with addicted patients, but he found he did. In his practice, he doesn’t just dole out drugs; he gives patients 24/7 followup until they’re physically comfortable and involved in some kind of support program.

2. I wanted to hear his clear-cut ideas about detoxing off opiates. He only does detox. He never does maintenance. Unlike so many other scientists, who believe people addicted to opioids can never stay off them, he believes we can get free.

“Believe me—it’s much more lucrative to do maintenance, to keep patients on Suboxone,” he said, adding that it’s even more profitable than, for example, doing Botox injections. Hundreds of practitioners—some of them with no experience with addiction—prescribe Suboxone as a maintenance drug, keeping patients on it for years at high levels and charging exorbitant cash fees. But for the vast majority of addicted people, Scanlan does not believe drug-maintenance is appropriate—or even safe. Buprenorphine is such a new drug, he says, and its long-term effects have not been adequately observed and researched.

He has said that Suboxone may curb cravings for other opiates and allow people to stop stealing and get their lives in order. But the problem is that, after three months or so, patients have terrible difficulties quitting Suboxone because of its sheer strength in binding to opiate receptors, its long half-life, and the fact that it’s a partial-agonist binding to receptors built for full agonists. And despite what the media tell us, there are many people who don’t want to spend a lifetime on high doses of Suboxone.

You know what? When I was detoxing off fentanyl in 2008, I felt so good on Suboxone that I thought about staying on it. Then something happened. I no longer felt so good. My feelings dulled. I no longer wanted food or sex. I realized my body was adapting to the drug—or trying to. Fortunately my outpatient detox doctor had no more slots for Suboxone maintenance patients, so I tapered off as quickly as I could. If my doctor had been operating under the new Comprehensive Addiction and Recovery Act, he may have had a slot for me, and I might have gotten trapped on Suboxone as so many others have.

Scanlan said most people, including physicians, do not comprehend the strength and effects of buprenorphine. “Everything changes in the body when you’re on opiates long-term—the way the body regulates pain, the way it regulates hormone production, sleep, emotions—everything,” he said. And buprenorphine, he repeats, is an opiate. Its effects are not just physical: as a psychiatrist, Scanlan has noticed in his practice that at long-term doses of just 2mg, Suboxone can block almost all of a person’s emotions.

In addition, buprenorphine’s half-life is 37 hours, which means it takes the body more than a day to excrete half the dose. When dosed once a day, the body doesn’t have time to catch up, so the drug builds up in the system—a phenomenon called “bioaccumulation” that Rachel Carson documented in the buildup of toxins among wildlife in her book Silent Spring. A patient dosing with buprenorphine at 8mg is not only getting 8mg—he’s getting the 8mg, plus the amount not yet metabolized from the day before (4mg). And 8mg is a low-end maintenance dose. In the U.S., patients are commonly dosed at 16mg or 24mg per day.

“There’s definitely a risk to going on Suboxone long-term—anything over three months,” he said. “It would be easier to detox patients if they were coming in at a year’s time at one milligram, or a half-milligram, which is where they should be. But they’re always coming in at 16 milligrams. Or 4 milligrams for four years but really they’ve been at 8 milligrams and they’ve lowered it just before they’ve come to see me. I have to get them to tell me what they’ve REALLY been taking.”

Scanlan is the only professional I’ve ever heard who can explain why the body reacts so differently to Suboxone than to full-agonist drugs like heroin, Vicodin and methadone. Read on…

Suboxone tablets

Suboxone 8mg tablets

G: Educate me about buprenorphine.

Scanlan: It’s the most amazing detox medication I’ve ever seen. But for maintenance—it’s harder to get off than methadone. Suboxone is 25-45 times as potent as morphine. It’s the king of the hill in terms of opiates—it displaces every other opiate off the receptors, except for Fentanyl. [Maintenance physicians] use way too much of it. When you build up to a serum level, it’s SO POTENT.

Americans should look at European countries’ use of buprenorphine. They’ve had it much longer than we have. They use lower doses; they have as much maintenance as we do. In Scandinavia, what do you think the number-one most-abused drug is?—buprenorphine. Simple facts: they’ve had it longer, and it’s the most abused drug. That’s what I’d like people to know about.

Buprenorphine is now the 41st most prescribed drug in the U.S. Five years ago, it was the 196th most prescribed. [Update, April 2016: Suboxone is now the 16th most prescribed drug in the U.S.] So you can see what a money machine it’s becoming. … The research to get Suboxone approved [by the FDA] was funded in conjunction with the NIH. Until the NIH is run by someone in recovery from addiction, this propaganda will continue. [National Institute on Drug Abuse Director] Nora Volkow is great, she’s smart, I’ve met her, but she doesn’t have a clue.

G: Why don’t you prescribe Suboxone as a maintenance drug?

S: I wasn’t against maintenance when I detoxed. But I’ve seen a lot since then. And I had a detox physician who told me, “Do NOT stay on this drug for more than three weeks, or else you’ll be dealing with a whole different problem.”

Buprenorphine is a partial-agonist opiate. It binds to the receptor and only activates it partway. Opiates are meant to bind to the receptors and activate them fully. But if you put something completely foreign in the body like a partial agonist, the body says, “What is this?” and it tries to reach homeostasis. It struggles to understand it as a full agonist, and it can’t. There is nothing in nature that is a partial agonist, and our opiate receptors are not designed to operate with partial-agonists. Buprenorphine definitely does something unnatural to the body.

I’m not against maintenance for a certain percentage of the population. I have a friend who runs a methadone clinic, and I think there’s a percentage of patients who need to be on maintenance for the rest of their lives. Perhaps five percent of the [addicted] population. If you want to do maintenance, though, you want to do methadone. Methadone at least has been used for a lot longer, and we understand it better.

G: How do you conduct detox?

S: To detox patients off long-term Suboxone, I use clonidine [a blood-pressure medication] and Librium [a benzodiazepine] because it’s more water-soluble. And I use Darvon, a weak opiate. Its half-life is short. … The Librium is the last to go. And they complain of disturbed sleep. I don’t use Seroquel because it can be abused. I use what acts on the antihistamine and melatonin receptors—the only two receptors they haven’t messed up yet. … It can take five months to get someone off long-term Suboxone.

For a Fentanyl detox, I give them Subutex. Fentanyl detox is the most brutal detox but it has the quickest recovery of the receptors because Fentanyl has such a short half-life.

I tell them to exercise. Studies show that 12 minutes of exercise per day with a heart rate of greater than 120 beats per minute restores the natural endorphin system in half the time. The people who do that, their sleep architecture returns to normal in half the time of people who don’t exercise. Twelve minutes. And of course you can do more.

G: And you urge them to join a recovery program?

S: They need some kind of support system. Let me tell you—everyone who’s stayed off Suboxone, they’ve been in AA or NA. Thirty-day inpatient programs have an average rate of 5 percent sober after one year. But from what I’ve seen in my practice, anyone who does an honest fifth step in AA or NA stays sober—the numbers are greater than 50 percent. And anyone who can do an honest ninth step and make amends, the number shoots up to over 90 percent.

Everyone who comes to me, I get them off opiates. One-quarter of the people I treat are sober at six months, and ninety percent of those are actively involved in some program. They’re not just going to meetings or involved in community service—they’re actively seeking some kind of spiritual growth. It all comes down to whether people want to do the work.

G: What about people who are afraid of becoming depressed after detoxing from long-term use?

I ask them, Was there ever a time you were sober? Did you have a bout of depression before then? If not, then it’s probably substance-induced. You have to take a thorough history. The statistics say: of all people who get clean, 15 percent have mental illness. Maybe a bit higher than the general population.

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Related posts:

How To Detox From OxyContin and Other Opiates

Reader Questions: Addiction, Chronic Pain, and Drug Maintenance

Have questions, or want to see someone interviewed here? Email me at guinevere (at) guineveregetssober (dot) com.

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